Comprehensive analysis of discharge reasons from methadone outpatient treatment programs

Abstract

Background and Objectives Methadone treatment (MT) for opioid use disorder is only available in opioid treatment programs (OTPs) in the United States, with retention predictive of positive health outcomes. OTP discharge reason information is needed to develop interventions for facilitating MT retention. We sought to identify discharge reason frequencies and associations between discharge reasons and facility/county‐level characteristics. Methods We examined annual OTP discharge reasons for all Florida OTPs from 2014 to 2017 (n = 44,774 discharges). We used multinomial logistic regression analysis to examine associations between patients’ discharge reasons and (1) facility‐level characteristics (e.g., size, funding type) and (2) county‐level characteristics (e.g., race/ethnicity, overdose rates). Results Lost contact was the most common discharge reason (29%). Only 11% of patients were discharged for treatment completion, with the proportion one‐third as low in privately versus publicly‐funded OTPs (p < .001). Privately‐funded OTPs had a patient share self‐terminating treatment against medical advice about 3.5 times higher than publicly‐funded OTPs. Inability to pay accounted for 7% of OTP discharges. Noncompliant discharges represented 6% and were more common in counties with larger proportions of Black residents (p < .01). Counties with higher drug overdose rates had significantly more discharges for noncompliance or self‐terminating against medical advice (p < .01 and p < .05). Discussion and Conclusions Statewide differences in discharge reasons exist between publicly and privately‐funded OTPs, possibly reflecting differences in funding incentives and state oversight. State agencies should develop consistent approaches for collecting/reporting discharge reasons. Scientific Significance Our study is the first to examine the relationship between OTP funding type and discharge reasons.

Treatment non-adherence among methadone maintenance patients and associated factors: a multicenter, cross-sectional study in Vietnam

“…Farmers had lower education levels (secondary schools or lower: 76.1%) and monthly income (80.51US$) in comparison with other occupation groups (secondary schools or lower: 49.6%, monthly income: 131.13US$). The inability to pay treatment costs can be a rationale behind patients’ treatment non-adherence and opioid treatment program discharge [ 23 ].…”

Outcomes of State Targeted/Opioid Response grants and the Medication First approach: evidence of racial inequities in improved treatment access and retention

“…This practice is discouraged under MedFirst principles yet national research suggests it is common in SUD treatment settings. [30][31][32][33] Because providers are more likely to discharge Black clients for these infractions 12 and to require Black clients to undergo urine drug screens in general, 12,34 it is possible Black clients in STR/SOR have not been afforded the same "low-barrier" MedFirst leniencies afforded to White clients.…”

Outcomes of State Targeted/Opioid Response Grants and the Medication First Approach: Evidence of Racial Inequities in Improved Treatment Access and Retention

“…This practice is discouraged under MedFirst principles yet national research suggests it is common in SUD treatment settings. [30][31][32][33] Because providers are more likely to discharge Black clients for these infractions 12 and to require Black clients to undergo urine drug screens in general, 12,34 it is possible Black clients in STR/SOR have not been afforded the same "low-barrier" MedFirst leniencies afforded to White clients.…”